Managed care plans have arrangements with certain physicians, hospitals and health care providers to serve patients who are plan members at a contracted reduced rate. Managed care plans usually offer a lower premium and require less paperwork. However, the choice of physicians, drugs and treatment are restricted. The insurer covers treatment provided by physicians and other medical service providers from the company's network (approved providers). This leaves the patient responsible for a designated co-payment or cost share.
Some plans offer benefits for care that is received outside the approved network of medical providers, but you pay a higher co-payment, as well as the difference in cost for the medical service.
A managed care health plan may only pay for medications that are on the insurer's list of approved drugs.
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